The history of diabetes: November 14 marks 100 years of insulin

Frequent urination was first documented in Egypt as a symptom of a mysterious disease that also caused increased thirst and emaciation.

Karen Hawthorne 7 minute read November 12, 2021
vintage photo of old book and stethoscope

In 1922, a fourteen-year-old was the first to receive an injection of purified insulin. GETTY

Every second, the pancreas secretes just the right amount of insulin or glucagon to lower or raise blood sugar. The secretion goes directly to the liver, the hub of life-sustaining metabolic processes, and then it’s delivered to all tissues in the body through circulation.

That’s how we all keep humming along.

But what happens when your pancreas can’t produce insulin or your body becomes resistant to insulin?

Diabetes is a disease that is becoming alarmingly common with about 3.7 million Canadians diagnosed and a market for medications in Canada that is expected to grow at a rate of nine per cent in the next five years reaching US$16.3 billion.

Where did it all start — and how far have we come in terms of treatment? Well, the history of this common disease goes back centuries.

Editor’s note: BCE stands for Before Common Era, CE stands for Common Era. 

1552 BCE Hesy-Ra, an Egyptian physician, first documents frequent urination as a symptom of a mysterious disease (known today as type 1 diabetes) that also caused increased thirst and emaciation. Doctors prescribe whole grains to help limit the symptoms, a dietary move research continues to support.

600 BCE The first clinical test for diabetes is spearheaded in India where patients have their urine tested by looking at whether ants were attracted to the urine because of high sugar levels. The diagnosis of “madhumeha” translates to “honey urine.”

100 CE Greek physician Aretaeus first uses the term “diabetes mellitus.” “Diabetes” comes means “to pass through,” in reference to the frequent urination and the belief that diabetes is a disease of the kidneys. “Mellitus” means “honeyed” in Greek, so the clinical term “diabetes mellitus” is similar to the “madhumeha” diagnosis in India.

20 CE The distinction between type 1 and type 2 diabetes is recognized in India and China. The causal relationship between obesity and type 2 diabetes is also noted because type 2 diabetes symptoms are seen to occur almost exclusively in overweight adults. Studies show obesity and inactivity are still considered leading contributors to type 2 diabetes.

1776 Liverpool physician and physiologist Matthew Dobson measures the concentration of glucose in the urine of diabetes patients — and finds it to be increased.

1812 Diabetes is a recognized clinical entity when the New England Journal of Medicine and Surgery is founded in 1812, although no effective treatment is available and diabetes is uniformly fatal within weeks to months after diagnosis because of insulin deficiency.

1889 German doctors Joseph von Mering and Oskar Minkowski at the University of Strasbourg discover that removing the pancreas from dogs causes them to develop diabetes and die shortly after. Understanding the role of the pancreas in regulating blood sugar levels shifts the focus of diabetes research from the kidneys to the pancreas.

1910 English physiologist Edward Albert Sharpey-Schafer link diabetes to the lack of a particular chemical produced by the pancreas. He calls it insulin, meaning island, because it’s produced by the cells in the islets of Langerhans in the pancreas.

1921 Canada proud! At the University of Toronto, Dr. Frederick Banting, and Charles Best, a medical student, introduces an extract of pancreatic islet cells from healthy dogs into dogs with diabetes. This reverses diabetes and marks the discovery of the hormone insulin. The two men work with two other U of T scientists, John Macleod, who provides them with lab space, equipment and dogs for testing, and James Collip, to purify insulin from the pancreas of cows and produce the first treatment for diabetes.

Bob Banting, Frederick Banting’s great nephew, says a lesser-known chapter in the discovery is the surreptitious test: Joe Gilchrist, a young doctor, former classmate and friend of Banting received insulin by mouth in the lab that December. He was dying of diabetes and had nothing to lose, so he signed a waiver to take the unproven insulin via a stomach tube. “He walked from the university to his boarding house, four or five blocks away,” Bob Banting says of Gilchrist, who survived because of the treatment. “He ended up feeling a surge of energy. When he got home, he was able to bound up the set of stairs. He recognized right away that something had happened.” The account of the first human patient is told in the 1988 TV movie, Glory Enough for All, based on the books by historian Michael Bliss.

Interesting, too, Gilchrist continued to work with Banting and Best in testing new insulin batches at the diabetes clinic established in 1922 at the Christie Street Military Hospital in Toronto where Gilchrist worked as a doctor. He tested each batch of insulin on himself when they were ready for human use.

1922Fourteen-year-old Leonard Thompson of Toronto is the first person to receive an injection of the purified insulin to treat diabetes. He lives another 13 years with the condition before dying of pneumonia.

1923 The discovery of insulin wins the Nobel Prize and by then, had saved millions of lives, allowing people with type 1 diabetes to live full, robust lives. U of T’s Connaught Antitoxin Laboratories starts ramping up insulin production and the university partners with pharmaceutical company Eli Lilly & Co. to begin large-scale production.

1936 British scientist Harold Percival Himsworth’s research distinguishes between type 1 and type 2 diabetes. He theorizes that many patients have insulin resistance, a factor that leads to type 2 diabetes, rather than insulin deficiency where the type 1 diabetic pancreas is not producing insulin.

Editor’s note: Type 1 diabetes is an autoimmune condition (where the body destroys its own cells) and type 2 is a metabolic disorder (where metabolism fails, leaving the body with too much or too little of the substances needed to stay healthy).

1980 Blood glucose monitors become available for home use, providing an accurate way to monitor blood sugar and store blood glucose history. This marks a turning point for better control for people who use insulin. They can now more easily measure their glucose levels to determine how much insulin they need and how well their treatment is working.

1982 The first genetically engineered, synthetic “human” insulin becomes available under the brand name Humulin, offering an extract that is identical to the body’s natural insulin.

1990 Smart, wearable insulin pumps that deliver a steady flow of insulin through a catheter under the skin, based on the instructions of the wearer are introduced.

1995 A number of non-insulin therapies for type 2 diabetes emerg during the 20th century that can be taken orally, including metformin. The discovery of metformin stems from the use of Gallega officinalis (also known as goat’s rue or French lilac), a plant traditionally used in Europe for diabetes.

2000 Continuous glucose monitors offer a sensor patch for the arm or abdomen that allow a patient to see blood sugar levels on a connected device in real-time to monitor exactly how levels react to food, exercise and medication.

2013 Artificial sweeteners in “diabetic-friendly” drinks and foods are found to cause a blood sugar spike and aren’t recommended as part of a healthy diet for diabetics, says a study by Washington University School of Medicine.

2017 Not everyone with type 2 diabetes uses insulin. Research increasingly shows that a healthful diet (plant-based is best), physical activity, not smoking and good sleep habits are important for preventing and managing type 2 diabetes. Then, a breakthrough study from Newcastle and Glasgow Universities, published in The Lancet, finds that a radical, low-calorie diet can reverse type 2 diabetes, even six years into the disease. Weight management is key.

Celebrity doctor Mehmet Oz helps spread the message of prevention on his TV show with a 60-day challenge for 60 Americans at risk for type 2 diabetes or diagnosed with the disease who are challenged to make four simple changes for better eating and exercise. Participants lose an average of 10 pounds and 2.5 inches.

2018 Researchers in Greece and the U.K. report in the BMJ that the artificial pancreas is “efficacious and safe” for people with type 1 diabetes to use. It combines an insulin pump and continuous glucose monitoring with a control algorithm to deliver insulin automatically.

2021 Is biotech getting us closer to a cure for diabetes? Early stage clinical trials are underway, including an experimental cell therapy pioneered at Harvard Stem Cell Institute where a type 1 diabetic patent is injected with cells that can make insulin. Symptoms are normal. Institute co-director and Xander University Professor Douglas Melton says the trial marks the most recent turning point in a decades-long effort to understand and treat the disease:

“The stem-cell-derived replacement therapy cells that have been put into this first patient were provided with a class of drugs called immunosuppressants, which depress the patient’s immune system,” said Melton. “They have to do this because these cells were not taken from that patient, and so they are not recognized as ‘self.’ Without immunosuppressants, they would be rejected. We want to find a way to make cells by genetic engineering that are not recognized as foreign. I think this is a solvable problem.”

November 14, 2021 is World Diabetes Day, and marks the 100th anniversary of the discovery of insulin and the first Nobel Prize to be awarded to Canada. Heroes of science and medicine, Frederick Banting, Charles Best, John Macleod and James Collip are joining Canada’s Walk of Fame.

Read Nicole Cleaver’s story about life with Type 2 diabetes here.